Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact firstname.lastname@example.org.
Temperature in Nursing Home Residents Systematically Tested for SARS-CoV-2
26 Pages Posted: 10 Jul 2020More...
Background: Many nursing home residents infected with SARS-CoV-2 fail to be identified with standard screening for the associated COVID-19 syndrome. Current nursing home COVID-19 screening guidance includes assessment for fever defined as a temperature of at least 38.0°C. We evaluated the temperature before and after universal testing for SARS-CoV-2 in nursing home residents.
Methods: The Veterans Administration (VA) operates 134 Community Living Centers (CLC), similar to nursing homes, that house residents who cannot live independently. VA guidance to CLCs directed daily clinical screening for COVID-19 that included temperature assessment. All CLC residents underwent SARS-CoV-2 testing once testing capacity could accommodate it. We report the temperature in the 14 days before and after universal SARS-CoV-2 testing among CLC residents.
Findings: Among the 7325 CLC residents, SARS-CoV-2 was identified in 443 (6.0%). The average maximum temperature in SARS-CoV-2 positive residents was 37.66 (0.69) compared to 37.11 (0.36) (p=0.001) in SARS-CoV-2 negative residents. Temperatures in those with SARS-CoV-2 began rising 7 days prior to testing and remained elevated during the 14-day follow up. Among SARS-CoV-2 positive residents, only 26.6% (n=118) met the fever threshold of 38.0°C during the survey period. Most residents (62.5%, n=277) with confirmed SARS-CoV-2 did experience two or more 0.5°C elevations above their baseline values. One cohort of SARS-CoV-2 residents’ (20.3%, n=90) temperatures never deviated >0.5°C from baseline.
Interpretation: A single screening for temperature is unlikely to detect nursing home residents with SARS-CoV-2. Repeated temperature measurement with a patient-derived baseline can increase sensitivity. The current fever threshold as a screening criteria for SARS-CoV-2 infection should be reconsidered.
Funding Statement: This work was funded by VA Health Services Research and Development and the National Institute of Aging 3P01AG027296-11S2
Declaration of Interests: The authors have declared no conflicts.
Ethics Approval Statement: This study was approved by the Providence VAMC Institutional Review Board.
Keywords: Fever; aged; care home; SARS-CoV-2; COVID-19; infectious disease; pandemic; geriatrics
Suggested Citation: Suggested Citation